内镜下不同术式对大肠侧向发育型肿瘤的治疗价值

Therapeutic Value of Different Endoscopic Procedures for Laterally Spreading Tumors of Large Intestine

目的:探讨内镜下不同治疗方法对较大(直径>20 mm)大肠侧向发育型肿瘤(LST)的治疗价值。方法:将2015年1月至2020年1月在宁德师范学院附属宁德市医院行预切开内镜下黏膜切除术(EMR)17例、内镜下黏膜分片切除术(EPMR)11例、内镜黏膜下剥离术(ESD)35例大肠LST患者进行回顾性研究,分别设置为预切开EMR组、EPMR组及ESD组。比较各组患者的手术时间、病灶治愈切除率、并发症发生率、复发率。结果:ESD组患者手术时间显著长于预切开EMR组、EPMR组,差异具有统计学意义(P<0.05)。预切开EMR组及ESD组整块切除率分别为94.1%、97.1%,差异无统计学意义(P>0.05)。治愈切除率,ESD组显著高于EPMR组,差异具有统计学意义(P<0.05),但与预切开EMR组比较差异无统计学意义(P>0.05)。手术并发症发生率在预切开EMR组、EPMR组、ESD组中分别为17.6%、18.2%(2/11)、5.7%(2/35),术后并发症发生率在ESD组中低于预切开EMR组、EPMR组,但差异无统计学意义(P>0.05)。结论:相比于EPMR,ESD、预切开EMR用于大肠LST治疗中具有更好的临床疗效,可提高对病灶组织的整块切除率及治愈切除率,降低术后并发症风险,可作为>20 mm大肠LST的优选治疗方法。

Objective To explore the therapeutic value of different treatment methods under endoscopy for larger(diameter greater than 20 mm)large bowel laterally spreading tumors(LST).Methods From January 2015 to January 2020,17 cases of endoscopic pre-cut mucosal resection pre-cut(EMR),11 cases of endoscopic piecemeal mucosal resection(EPMR)and 35 cases of endoscopic submucosal resection(ESD)were performed in Ningde Hospital Affiliated to Ningde Normal University.A retrospective study was conducted on these cases.They were set into pre-cut EMR group,EPMR group,and ESD group to compare the operation time,resection rate,complications and recurrence rate.Results The operation time of ESD group was significantly longer than that of EMR group and EPMR group,the difference was statistically significant(P<0.05).The block removal rates of pre-incision EMR group and ESD group were 94.1%and 97.1%,respectively,with no statistical significance(P>0.05).The cured resection rate in ESD group was significantly higher than that in EPMR group,and the difference was statistically significant(P<0.05),but there was no significant difference between ESD group and EMR group(P>0.05).The incidence of surgical complications in pre-cut EMR group,EPMR group and ESD group was 17.6%,18.2%(2/11)and 5.7%(2/35),respectively.The incidence of postoperative complications in ESD group was lower than that in pre-cut EMR group and EPMR group,but the difference was not statistically significant(P>0.05).Conclusion Compared with EPMR,ESD and pre-cut EMR have a better clinical effect in the treatment of large intestine LST,which can improve the en bloc resection rate and the cure resection rate of the lesion,and reduce the risk of postoperative complications.They can be used as the preferred treatment method for LST of large intestine larger than 20 mm.